ASGE Postgraduate Course at ACG: Evidence-based Updates for the Practicing Gastroenterologist | October 2021-4_Gutierrez_ASGE

4_Gutierrez_ASGE_Anticoagulation in endoscopy

Pdf Summary

This document discusses the evidence-based approach to peri-procedural anticoagulation. It emphasizes the importance of considering various factors, such as the patient's medical conditions, the type of antithrombotic medication being used, the bleeding risk of the procedure, and whether the procedure is elective or urgent. Common antithrombotic medications are listed along with their main indications, mechanisms of action, and durations of action. The document provides guidelines for stopping and resuming antithrombotic medications based on these factors.<br /><br />For elective procedures, the decision to stop or continue anticoagulation depends on the specific medical conditions and the type of procedure. In some cases, the procedure can be deferred, while in others, short-term antithrombotic therapy may be recommended. There are specific recommendations for patients with venous thromboembolism, coronary stents, non-valvular atrial fibrillation, and mechanical heart valves.<br /><br />For colonoscopies with polypectomy, the document highlights the importance of considering polyp size when deciding on the need for prophylactic clipping and provides recommendations for stopping and resuming antithrombotic medications in these cases.<br /><br />In the event of urgent procedures or if bleeding occurs during or after a procedure, there are guidelines for managing patients on warfarin, direct oral anticoagulants, and antiplatelet therapy. These guidelines involve holding the medication, administering specific reversal agents if necessary, and resuming the medication once hemostasis is achieved.<br /><br />The document also emphasizes the importance of communication with the prescribing provider before stopping or resuming antithrombotic medications and concludes with a quote highlighting the priority of heart health.<br /><br />Overall, this document provides a comprehensive overview of the evidence-based approach to peri-procedural anticoagulation, emphasizing the importance of individualized decision-making based on the patient's medical history and the specific procedure being performed.

Keywords

evidence-based approach

peri-procedural anticoagulation

patient's medical conditions

antithrombotic medication

bleeding risk

elective procedure

urgent procedure

venous thromboembolism

coronary stents

non-valvular atrial fibrillation